Arjun Nair

Arjun Nair
Guy's and St Thomas' NHS Foundation Trust · Department of Radiology

MD MRCP FRCR

About

95
Publications
20,476
Reads
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2,483
Citations
Introduction
Skills and Expertise
Additional affiliations
October 2005 - September 2012
National Health Service
Position
  • Radiology SpR and Fellow
October 2005 - September 2011
St George's, University of London
Position
  • Radiology SpR

Publications

Publications (95)
Article
Full-text available
Objectives Successful lung cancer screening delivery requires sensitive, timely reporting of low-dose computed tomography (LDCT) scans, placing a demand on radiology resources. Trained non-radiologist readers and computer-assisted detection (CADe) software may offer strategies to optimise the use of radiology resources without loss of sensitivity....
Preprint
Full-text available
Lung cancer is the leading cause of cancer-related mortality worldwide. Lung cancer screening (LCS) using annual low-dose computed tomography (CT) scanning has been proven to significantly reduce lung cancer mortality by detecting cancerous lung nodules at an earlier stage. Improving risk stratification of malignancy risk in lung nodules can be enh...
Article
Objectives In patients with IPF, this study aimed (i) to examine the relationship between serial change in CT parameters of lung volume and lung function, (ii) to identify the prognostic value of serial change in CT parameters of lung volume, and (iii) to define a threshold for serial change in CT markers of lung volume that optimally captures dise...
Article
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Background The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. Methods From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation...
Article
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Background Idiopathic pulmonary fibrosis (IPF) and pleuroparenchymal fibroelastosis (PPFE) are known to have poor outcomes but detailed examinations of prognostic significance of an association between these morphologic processes are lacking. Methods Retrospective observational study of independent derivation and validation cohorts of IPF populati...
Article
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In patients with combined pulmonary fibrosis and emphysema, emphysema and fibrosis do not have a synergistic effect that results in worsened survival when compared to IPF patients without emphysema https://bit.ly/35EJMo6.
Article
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Large numbers of people are being discharged from hospital following COVID-19 without assessment of recovery. In 384 patients (mean age 59.9 years; 62% male) followed a median 54 days post discharge, 53% reported persistent breathlessness, 34% cough and 69% fatigue. 14.6% had depression. In those discharged with elevated biomarkers, 30.1% and 9.5%...
Article
Lung cancer kills an estimated 35 000 people in the UK every year. Despite the improvements in treating late-stage disease, lung cancer outcomes have changed little in the last 40 years. Low-dose CT (LDCT) screening for lung cancer reduces lung cancer mortality by 20%–24% and all-cause mortality by 7%.1 2 Lung cancer screening (LCS) however remains...
Article
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The Lung Screen Uptake Trial tested a novel invitation strategy to improve uptake and reduce socioeconomic and smoking-related inequalities in lung cancer screening (LCS) participation. It provides one of the first UK-based ‘real-world’ LCS cohorts. Of 2012 invited, 1058 (52.6%) attended a ‘lung health check’. 768/996 (77.1%) in the present analysi...
Article
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The Dutch-Belgian NELSON trial recently confirmed that screening for lung cancer with low radiation dose computed tomography (LDCT) reduces lung cancer mortality (1). This is a major contribution and has been long-awaited by some countries to support calls for implementation of screening programmes. NELSON has also provided invaluable information a...
Article
Rationale: Individuals eligible for lung cancer screening (LCS) by low-dose computed tomography (LDCT) are also at risk of Chronic Obstructive Pulmonary Disease (COPD) due to age and smoking exposure. Whether the LCS episode is useful for early detection of COPD is not well established. Objectives: To explore associations between symptoms, comor...
Article
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Increasing bacterial burden in the lower airways of patients with idiopathic pulmonary fibrosis confers an increased risk of disease progression and mortality. However, it remains unclear whether this increased bacterial burden directly influences progression of fibrosis or simply reflects the magnitude of the underlying disease extent or severity....
Article
Full-text available
Introduction Lung cancer screening (LCS) by low-dose computed tomography (LDCT) offers an opportunity to impact both lung cancer and coronary heart disease mortality through detection of coronary artery calcification (CAC). Here, we explore the value of CAC and cardiovascular disease (CVD) risk assessment in LCS participants in the Lung Screen Upta...
Article
OBJECTIVE. The purpose of this study is to establish the relationship between CT markers of lung volume and pulmonary function test (PFT) parameters of lung volume in idiopathic pulmonary fibrosis (IPF). MATERIALS AND METHODS. The relationships between PFT-derived parameters of lung volume (forced vital capacity [FVC] and total lung capacity [TLC])...
Article
Objectives To describe the challenges inherent in diagnosing fibrosing lung diseases (FLD) on CT imaging and methodologies by which the diagnostic process may be simplified. Methods Extensive searches in online scientific databases were performed to provide relevant and contemporary evidence that describe the current state of knowledge related to...
Article
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Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological variation in 1) pulmonary nodule characterisation; 2) hypothetical guideline-derived management; and 3) radiologists' management recommendations. 107 radiologists from 25 countries evaluated 69 CT-d...
Article
The accurate identification and characterization of small pulmonary nodules at low-dose CT is an essential requirement for the implementation of effective lung cancer screening. Individual reader detection performance is influenced by nodule characteristics and technical CT parameters but can be improved by training, the application of CT technique...
Article
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Aims: To determine whether computer-derived computed tomography measures, specifically measures of pulmonary vessel-related structures, can better predict functional decline and survival in idiopathic pulmonary fibrosis (IPF) and reduce requisite sample sizes in drug trial populations. Methods: IPF patients undergoing volumetric non-contrast CT...
Article
European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using t...
Article
Background and objective: This study evaluated whether patients with combined pulmonary fibrosis and emphysema (CPFE) have an increased likelihood of pulmonary hypertension (PHT) when compared with idiopathic pulmonary fibrosis (IPF) patients without emphysema. Methods: Two consecutive IPF populations having undergone transthoracic echocardiogra...
Article
Objectives: To determine whether computer-based CT quantitation of change can improve on visual change quantification of parenchymal features in IPF. Methods: Sixty-six IPF patients with serial CT imaging (6-24 months apart) had CT features scored visually and with a computer software tool: ground glass opacity, reticulation and honeycombing (al...
Article
A consistent feature of many lung nodule management guidelines is the recommendation to evaluate nodule size by using diameter measurements and electronic calipers. Traditionally, the use of nodule volumetry applications has primarily been reserved for certain lung cancer screening trials rather than clinical practice. However, even before the firs...
Article
This study aimed to investigate whether the combination of fibrosis and emphysema has a greater effect than the sum of its parts on functional indices and outcome in idiopathic pulmonary fibrosis (IPF), using visual and computer-based (CALIPER) computed tomography (CT) analysis. Consecutive patients (n=272) with a multidisciplinary IPF diagnosis ha...
Article
Background Unclassifiable-interstitial lung disease (uILD) represents a heterogeneous collection of pathologies encompassing those fibrosing lung diseases which do not fulfill current diagnostic criteria. We evaluated baseline and longitudinal functional and CT (visual and quantitative computer [CALIPER] analysis) variables to identify outcome pred...
Article
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Objectives: To compare radiologists' performance reading CTs independently with their performance using radiographers as concurrent readers in lung cancer screening. Methods: 369 consecutive baseline CTs performed for the UK Lung Cancer Screening (UKLS) trial were double-read by radiologists reading either independently or concurrently with a ra...
Article
Computer-based computed tomography (CT) analysis can provide objective quantitation of disease in idiopathic pulmonary fibrosis (IPF). A computer algorithm, CALIPER, was compared with conventional CT and pulmonary function measures of disease severity for mortality prediction. CT and pulmonary function variables (forced expiratory volume in 1 s, fo...
Article
Background: Pulmonary hypertension (PH) in interstitial lung disease (ILD) is often associated with significant morbidity and mortality. Right heart catheterization (RHC) remains the gold standard diagnostic investigation for PH, although co-existing ILD can confound interpretation of non-invasive PH screening tests. We evaluated the utility of ind...
Article
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Objective: To compare the performance of radiographers against that of radiologists for CT lung nodule detection in the UK Lung Cancer Screening (UKLS) pilot trial. Methods: Four radiographers, trained in CT nodule detection, and three radiologists were prospectively evaluated. 290 CTs performed for the UKLS were independently read by 2 radiolog...
Article
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Aims Cardiac perforations caused by pacemaker or implantable cardioverter-defibrillator (ICD) leads are uncommon but potentially fatal events. The optimal approach to such cases is unclear. The aim of this study was to identify the optimal imaging modality and management strategy for cardiac perforation. Methods and results All patients presenting...
Article
Purpose: The aim of the study was to determine whether a novel computed tomography (CT) postprocessing software technique (CALIPER) is superior to visual CT scoring as judged by functional correlations in idiopathic pulmonary fibrosis (IPF). Materials and methods: A total of 283 consecutive patients with IPF had CT parenchymal patterns evaluated...
Article
Introduction: Cardiac perforations caused by pacemaker (PM) or implantable cardioverter defibrillator (ICD) leads are uncommon but potentially fatal events. In the absence of clear evidence, optimal methods for diagnosis and management remain unclear. Methods: All patients presenting to a single institution with cardiac perforation over the period...
Article
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Background: Lung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects. Objectives: To (1)...
Article
A 24-year-old man was referred to the haematologists for investigation of unexplained anaemia on the background of a 6-month history of exertional breathlessness, mild cough and night sweats. Investigations revealed iron-deficiency anaemia (haemoglobin 94 g/L), thrombocytosis and markedly elevated inflammatory markers (C-reactive protein (CRP) 235...
Article
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The aim of this review is to give a comprehensive and concise overview of coronary embryology and normal coronary anatomy, describe common variants of normal and summarize typical patterns of anomalous coronary artery anatomy. Extensive iconography supports the text, with particular attention to images obtained in vivo using non-invasive imaging. W...
Article
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Background Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. Methods The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk indiv...
Article
Aim: To describe a technique for bioprosthetic multidetector computed tomography (MDCT) sizing and to compare MDCT-derived values against manufacturer-provided sizing. Materials and methods: Fourteen bioprosthetic stented valves commonly used in the aortic valve position were evaluated using a Philips 256 MDCT system. All valves were scanned usi...
Article
To discuss the imaging of interstitial lung disease believed to be caused by smoking. It is increasingly clear that smoking is associated with a variety of patterns of interstitial lung disease. The radiologic features of interstitial lung disease caused by smoking cigarettes are variable and may be nonspecific. It is now accepted that cigarette sm...
Article
Lung clearance index (LCI) is a potential clinical outcome marker in bronchiectasis. Its responsiveness to therapeutic intervention has not been determined. This study evaluates its responsiveness to a session of physiotherapy and intravenous antibiotic treatment of an exacerbation.32 stable and 32 exacerbating bronchiectasis patients and 26 health...
Article
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Dynamic hyperinflation (DH) is a pathophysiologic hallmark of Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to investigate the impact of emphysema distribution on DH during a maximal cardiopulmonary exercise test (CPET) in patients with severe COPD. This was a retrospective analysis of prospectively collected data among se...
Article
In a subgroup of patients with systemic sclerosis (SSc), vasospasm affecting the pulmonary circulation may contribute to worsening respiratory symptoms, including dyspnea. Noninvasive assessment of pulmonary blood flow (PBF), utilizing inert-gas rebreathing (IGR) and dual-energy computed-tomography pulmonary angiography (DE-CTPA), may be useful for...
Article
Lung disease commonly occurs in connective tissue diseases (CTD) and is an important cause of morbidity and mortality. Imaging is central to the evaluation of CTD-associated pulmonary complications. In this article, a general discussion of radiologic considerations is followed by a description of the pulmonary appearances in individual CTDs, and th...
Article
Acute pulmonary embolism is recognized as a difficult diagnosis to make. It is potentially fatal if undiagnosed, yet increasing referral rates for imaging and falling diagnostic yields are topics which have attracted much attention. For patients in the emergency department with suspected pulmonary embolism, computed tomography pulmonary angiography...
Article
Background: Dynamic hyperinflation (DH) is a major contributor of both dyspnea and reduced exercise capacity among patients with chronic obstructive pulmonary disease (COPD). The relationship between the pattern of distribution of emphysema (homogeneous versus heterogeneous) and DH has not been previously studied. The aim of the study was to compar...
Article
Introduction and objectives LCI is a sensitive predictor of early cystic fibrosis (CF) lung disease, and correlates with HRCT better than spirometry (Thorax. 2008;63:129–134). The same is true in adults with non-CF bronchiectasis (Am J Respir Crit Care Med. 2014;189:586–592.), but by contrast, in PCD there were no relationships between LCI, HRCT or...
Article
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Computed tomography (CT) is routinely used in the evaluation of patients with pulmonary hypertension (PH) to assess vascular anatomy and parenchymal morphology. The introduction of dual-energy CT (DECT) enables additional qualitative and quantitative insights into pulmonary hemodynamics and the extent and variability of parenchymal enhancement. Lun...
Article
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Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by high morbidity and mortality. Lung computed tomography parameters, individually or as part of a composite index, may provide more prognostic information than pulmonary function tests alone. Aim: To investigate the prognostic value of emphysema score and pulmonary arte...
Article
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Objective To describe the clinical outcomes of patients for whom National Institute for Health and Care Excellence (NICE) recent-onset chest pain guidance would not have recommended further investigation, compared with those of patients where further investigation would have been recommended. Methods 557 consecutive patients with recent-onset chest...
Article
Background: COPD and radiographic bronchiectasis frequently coexist but the effect of this on the clinical course of COPD is not fully understood. We determined the impact of bronchiectasis on clinical outcomes in COPD patients, independent of coexisting emphysema and bronchial wall thickening (BWT). Methods: COPD patients admitted with first ex...
Article
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Background: Ataluren acts at the level of the ribosome to enable readthrough of premature termination codons and production of full-length CFTR protein in individuals with CF carrying nonsense mutations (nmCF). Methods: This Phase 3, open-label extension study enrolled patients who had completed the preceding 48-wk randomized double-blind study (St...
Article
Pulmonary disease is common in patients with connective tissue disease (CTD) and confers significant morbidity and mortality. High-resolution computed tomography (HRCT) provides considerable information regarding the distribution and severity of thoracic disease in CTD. Different anatomical compartments of the lung can be simultaneously affected in...
Article
Background: The development of ivacaftor represents a significant advance in therapeutics for patients with cystic fibrosis (CF) who carry the G551D mutation. Patients with an FEV1 < 40% predicted represent a considerable proportion of eligible patients but were excluded from phase 3 clinical trials, and the effectiveness of the drug in this popul...
Article
The smoking-related interstitial lung diseases (ILDs) comprise several diseases that often coexist. In this review, the high-resolution computed tomography (CT) features and pathologic correlates of the traditional smoking-related ILDs (respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, and pulmonary Langerhans cell hist...
Article
IntroductionDynamic hyperinflation (DH) is a major contributor of both dyspnea and reduced exercise capacity among patients with Chronic Obstructive Pulmonary Disease (COPD). The relationship between the pattern of distribution of emphysema (homogeneous versus heterogeneous) and DH has not been previously studied.AimTo compare the impact of emphyse...